Healthcare Provider Details

I. General information

NPI: 1679629273
Provider Name (Legal Business Name): HEIDI COOK-ANDERSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR UCSD, BSB 5046B, 0633
LA JOLLA CA
92093-0633
US

IV. Provider business mailing address

9500 GILMAN DRIVE UCSD, BSB 5046B, 0633
SAN DIEGO CA
92093-0633
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-8930
  • Fax:
Mailing address:
  • Phone: 858-534-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL-1573
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA109996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: